Accreditation & Software

• By Bently C. Goodwin
• Dec 01, 2007

Providers cite many reasons for procrastinating on accreditation. Some providers have put it off because the Centers for Medicare and Medicaid Services (CMS) has not yet issued a final deadline for accreditation. Other providers are hoping they are located in a city that won’t be named for the next wave of competitive bidding. And other providers, after reviewing the quality standards, may have determined that the process seems too cumbersome to dive in and complete it immediately. No matter what the reasoning, if providers want to bill Medicare in the future, accreditation will be required.

Discussing the importance of providers seeking accreditation, Sandy Cannally, founder and president of The Compliance Team says, “This is providers’ livelihood; it is their business.”

In order to make the accreditation process and compliance with the quality standards easier, software programs can help. The quality standards for accreditation require a vast amount of information to be tracked and documented, and having the right software can be instrumental for seamless business operations.

Cannally says the number one way software and accreditation are connected is through inventory tracking. “A lot of people out there still do not have computerized tracking. We have an all-inclusive manual, but providers need to get to the next, computerized, level. Providers need to know where their inventory is at all times. In the event of any type of recall, providers need to be able to identify where that serial number is at any given moment. That is what an accreditor will look for.”

Software is also used for tracking maintenance and preventative maintenance. Cannally says, “For example, ‘This is what happened with this concentrator.’ You can sort by due dates of preventative maintenance and find out when the preventative maintenance is due next. The easiest way to track that information is on a computer. We look at it from a standpoint: Can providers look for where that serial number is? Does it show history on that machine? How many patients have used that concentrator in the last three months? That’s what providers need to look for in choosing a software package.”

Cannally says that software also helps with databases for physicians, by having a place to verify physicians’ licenses.

Another connection between accreditation and software is claims monitoring. Cannally says, “How often do providers have denials? Who are providers getting denials from? Software can offer more than just equipment management when it comes to accreditation, it also can offer corporate compliance and administration.”

Although some smaller providers do not currently have software systems, Cannally recommends that most providers have software to cover the basics. Generally two-tiered in terms of the expense, there is software that consists of a basic package allowing providers to know where the equipment is, but there is another tier of software that handles more comprehensive reports, history and advanced tools.

“If a provider needs to do purchase software in steps, that’s fine too,” Cannally says. “As they are able to, they can add that component. It is tough to see any providers that aren’t computerized at this point, but we can give them manual tools to use.”

Roberta Domos, RRT and owner of Domos HME Consulting Group, lists the following ways HME software programs can help providers achieve accreditation:

• Tracking serial numbers of rental items provided to patients for recall purposes.
• Tracking lot numbers of oxygen or respiratory medication to patients for recall purposes.
• Tracking due dates, and recording the preventative maintenance history of serialized rental items.
• Tracking prescriptions that are about to expire to notify the provider that a new prescription is required.
• Tracking patient follow-up visits so that they can be completed on time, according to company policy and standard of care.
• Logging complaints as required by accreditation standards.
• Aggregating and assessing Medicare denials and coding errors through analysis of the ERN file.

Asked whether accreditation is gaining speed for providers who suspect they might be named for the second wave of competitive bidding, Cannally says, “We are definitely seeing an increase in interest. It is no where close to where it needs to be, but we are getting there. Providers know it is inevitable, but they don’t feel the urgency. I have told my people in the field that when you are talking to anyone, look at the list of the 100 largest metropolitan statistical areas (MSAs) and look at the top 80 and that is who we need to focus on — after taking out the first 10 MSAs — look at the statistical chances of the next likely cities.”

Cannally hopes that CMS gives more than six months when it releases the final deadline on accreditation. “People need to know this: It is not just the DMEs and the pharmacies that this affects, the Medicare Modernization Act of 2005 (MMA) is so far-reaching with accreditation, it also affects all the podiatrists, orthopedic surgeons, nursing homes that do DME, maybe enteral — food and nutritional services — the opthamologists, the anaplastologists, etc. Now picture 10 accrediting bodies accrediting everything, there are only a handful of us that can accredit everything. Not all 10 approved accrediting bodies are approved across the board for everything. Providers need to look at CMS Web site as it relates to the different accrediting bodies and what they are approved to accredit. Some accrediting bodies might accredit prosthetics, but not power chairs,” Cannally says.

 Software Companies Discuss the Connection

• Generates reports and data tracking.
• Automates the process of new patient documentation.
• Provides detailed patient notes.
• Tracks serial and lot numbers, delivery of products, equipment maintenance and history.
• Tracks key product information.
• Tracks equipment maintenance.
• Offers complete history of the lifespan of products.
  

“Accreditation for HME providers is essential today in order to compete effectively in the home care market. From a patient safety standpoint, Fastrack supports accreditation for HME providers specifically in the technology that we utilize and leverage in the development of our software. The ability to accurately track equipment history, maintenance and settings, as well as education for patients and their families is essential to understanding that equipment’s efficiency in the administration of various therapies. In order to adequately understand the life performance of a piece of equipment and whether it is safe and effective for patient care, bar coding, wireless inventory tracking and delivery confirmation, providing for real-time information on these pieces of equipment is essential. This is important not only to patient care and safety, but to the health and growth of the business overall.” — Spencer Kay, Fastrack Healthcare Systems

“Accreditation helps providers better understand and operate their businesses more efficiently. To that end, accreditation includes helping HME businesses to better manage their inventory and their accounts receivable. Accreditation will also push HME businesses to utilize the HME software for more than just a billing program to get claims paid. HME businesses will want to automate as many features as possible.” — Jay Williams, QS/1

“Continuing Quality Improvement (CQI) is a big part of the accreditation process. RemitDATA provides tools that allow providers to monitor reimbursement performance and implement a continuous quality improvement process around the reimbursement function. The tools allow internal benchmarking and industry benchmarking. RemitDATA provides productivity tools that allow for process improvement by reducing the time necessary for following up on denials and processing secondary invoices. All of this empowers a provider to reduce denial rates, reduce total time spent on reimbursement and accelerate cash flow.”

This article originally appeared in the December 2007 issue of HME Business.